Sleep Hygiene September || Take 2 Tips: Perfect Pillows

AUG 3 || MASHABLE
This pillow streams music, but doesn't wake your partner
"The creator explained that the idea came from his own sleep troubles. He wanted to play music, but didn't want to disturb his wife, so he shoved a pair of wireless headphones into a pillow. .. 'To my surprise, I was able to hear the music, but my wife wasn't, 'Cofounder Warrick Bell said. "I knew I was onto something.' "

AUG 8 || DOCTOR STEVEN PARK
The Best Pillow For A Great Night’s Sleep
"But there’s one thing about pillows that’s almost never addressed directly: how pillows can affect your airway and breathing at night. Granted there are generic descriptions of anti-snoring pillows, but an explanation of how they work is not usually given."

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SLEEP HYGIENE TIP OF THE WEEK: Clean your bedroom!

This isn't just advice for those messy teenagers with wet towels on their bedroom floors, unmade beds, collections of soiled dishes, and mounds of dirty laundry in direct contact with the space where they sleep.

Even though recent studies suggest that teenagers may have problems with sleep thanks to the smells coming from their bedrooms, the problem of messy, unkempt sleep spaces is not limited only to people in their age bracket.

How we keep our bedrooms has a direct impact on the quality of sleep we can expect at night. The three main areas of concern for any bedroom center on comfort, clutter, and sanitation.


Comfort

Comfort matters. If we are uncomfortable, we can't relax, and if we can't relax, sleep will be hard to come by. Don't shortchange yourself basic comfort at the end of the day. It's not really optional, much in the same way sleep is not optional.

• Have you ever noticed... an unmade bed is not comfortable to climb into at the end of a very long day. A made bed is inviting, smooth, and enveloping. Show yourself five minutes of self-love in the morning by making your bed. You will thank yourself after a long, hard day.
  
• Flat pillows that are no longer "plumpable" need to be replaced, not only because they are no longer comfortable, but because they can contribute to neck and shoulder pain and problems with breathing. They can also harbor microorganisms if they are not cleaned properly. You can simplify this by bagging your pillows with washable liners before placing them into cases.
  
• Mattresses that are lumpy, caving in at the center, missing their bounce, damaged by fluids, or which have springs poking through the surface need to be replaced. Most mattresses last about 10 years. Again, this is not only a comfort measure (which still counts as good sleep hygiene) but also critical to avoiding back and hip problems. Pain is the enemy of sleep; don't let your bed be the reason you can't sleep!
  
• Room temperature is much more critical to good sleep hygiene than you might think. A cooler room not only means it will be less stuffy, but it means your body will be better prepared for sleep. The body's thermostat makes important changes during the sleeping period that are a reflection of the circadian system. Too warm a room can mean your core body temperature is not cool enough to allow for quality sleep. Lower your thermostat and add more blankets in layers that you can adjust throughout the night if you find it hard to sleep in a cool room.

Clutter


There's plenty of discussion these days about how to keep up with clutter, how to deep clean personal spaces, and why decluttering is good for your overall mental health. This definitely relates to the bedroom as much as to the more active living spaces in your home.

• If you take work with you to bed, the chances are high you have a nearby mess of pens, papers, folders, electronics, notepads, or paperwork that is cluttering the space. This clutter can not only get in the way of sleeping (literally), but it's also an unpleasant reminder of work "still to do." It's quiet presence alone can fuel racing thoughts at bedtime and prevent sleep onset. Also, waking up to reminders of unfinished work is not exactly a good way to rise and shine. Best practice: Don't take your work to bed with you.
  
• General clutter has been shown to negatively alter important cognitive functions and mood (as well as serve as a dust magnet!—See Sanitation below). Is this how you want to wake up in the morning? How you want to go to bed at night? Think about it. Television's popular home improvement shows frequently describe how the bedroom should be a "sanctuary," and they are right on. Your bedroom should be a welcoming space, not one that you dread going to or waking up in.
  
• Do you use your bedroom as a storage space to make other rooms in your home more accessible? You might want to rethink this habit, not only for the purposes of "preserving your sanctuary," but because a bedroom's main purpose is for sleep and intimate time with your partner. The clear delineation between your sleeping space and your living space is not accidental; living space is for living, sleeping space is for sleeping. When these two purposes collide, anxiety enters the picture and messes with both the sleep and wake portions of your daily life.

Sanitation

This is the most obvious reason to keep your bedroom clean, but it bears repeating. We all get busy and don't always make housekeeping the priority. Here are some reminders why getting out the vacuum and the window cleaner are not only investments in your home, but also in your health.

• If you don't vacuum or dust regularly, all those particulates in the carpets, the bedding, the air, and collecting along the woodwork can worsen air quality and lead to congestion, allergies, and all the other upper respiratory problems we normally attribute to air pollution. Make sure any air intakes or filters are regularly cleaned (or filters changed) to improve air quality.
  
• The same goes for clean sheets and pillowcases: your body sheds skin cells and bodily fluids at night even if you don't notice them. These can create an environment for bacteria as well as leave odors and contribute to allergies. Anyway, clean linens smell great and feel great!
  
• Dirty laundry smells just as bad in an adult's bedroom as it does in a teen's room. The term "nose-blind" seems appropriate to use here (see also "Why can't you smell your own home?"). It describes our inability to note the odors in our own personal living spaces even as strangers entering the house may notice them right away. This isn't a missive on aromatherapeutics, however. Spraying a fragrance does not fix the underlying problem. Odors you don't notice in your own sleeping space still introduce bacteria in the airspace and become part of "room air," which you breathe all night long.
  
• Recycled air in a bedroom, even when the laundry isn't allowed to pile up, becomes less "aerobic" when the windows are sealed shut all the time. Anaerobic means that the amount of oxygen available to you as "room air" is not adequate for good health in the long term: it contains less oxygen, which your bloodstream requires for sustaining the body's myriad functions. "Room air" is measured normally as 21 percent of any space's atmosphere (that is to say, 21 percent of the atmosphere you breathe is composed of oxygen). The less aerobic the air in your bedroom means your body, over time, will need to compensate in other ways—such as by altering the respiratory rate—so that you can maintain a healthy oxygen balance in your bloodstream. (Read this interesting discussion of what happens to a human locked in an airtight room for some ideas about why.) But the solution is pretty simple: Most homes are meant to "gas off" to help achieve a healthy, balanced atmosphere; briefly opening the windows, even in winter for just a few minutes, can make all the difference.

• Check your windows for mold patches and any mildew formed around the frames or inside the mesh screens. These can enter your airspace and lead to disease. Wipe windows, frames, and screens regularly—frequently if you have windows that leak air or water. Moisture and/or oxygen in a warm space can provide the breeding ground for microorganisms, which can detract from your bedroom's air quality. 

Making New Year's Resolutions? Put sleep at the top of your list

"Almofadas" by Castelaa - Own work. Licensed under Public Domain via Wikimedia Commons

Here are 10 simple ways to add "better sleep" to your goals for 2016:

1. Put your smartphones and other handheld electronic devices away 1 HOUR BEFORE BED.
2. Eat smaller, leaner portions at dinnertime at least two (ideally three) hours before bed.
3. Spray lavender mist on your pillow at bedtime.
4. Learn yogic breathing and practice it if you are struggling to sleep.
5. Wear an eye mask if streetlights outside are keeping you awake.
6. Invest in a new pillow. It doesn't have to be expensive, it just has to support your neck and spine.
7. Drink an ice-cold glass of water at bedtime to help encourage a lower core temperature for sleep.
8. Give yourself permission to nap... and then take a nap if you need one.
9. Use a saline nasal spray at bedtime to keep your nasal and sinus passages clear.
10. Stop all consumption of caffeine products by no later than 3pm.

JUST BREATHE: What happens if I don't want or like PAP therapy? You have options

It's no secret that some people don't like PAP therapy (nor is it a secret that some people swear by it). Therapies that require the use of devices can be challenging for some people and even with their best efforts, they may not  be able to use them effectively.

Below is a list of options for those who have tried and failed at PAP therapy for whatever reason. It is not the purpose of this website to favor one therapy or another, or to compare and contrast, but rather to illustrate the variety of options that patients with sleep-disordered breathing may have.As always, your diagnoses and treatments are best discussed with your sleep physician, as this website cannot diagnose your problem or prescribe or advise as to which options are best for you. Whether you qualify for any of these treatments is going to be a decision you make with your physician. 

• Oral devices. Read here for a more detailed discussion about sleep dentistry and how it might help you. 
• Expiratory positive airway pressure. This is a kind of nostril patch device that works by blowing against the patches during exhale, which may improve the "patency" or rigidity of the upper airway tissue and provide, for some, a kind of "tracheal traction" to create greater ease in inhalation. 
• Oral pressure therapy. This works by using a small oral suction tube to draw the soft palate forward, which may stabilize the tongue and keep it from blocking the airway during sleep.
• Pillar procedure. This is a minimally invasive surgical procedure in which tiny implants are inserted into the soft palate. Their presence may reduce tissue vibration which can lead to snoring, sleep apnea and upper airway resistance syndrome. 
• Somnoplasty. This is a minimally invasive surgical procedure using radio frequency (RF) energy to sculpt upper airway tissue under local anesthesia; this may effectively open the airway.
• Upper airway neurostimulation. The Inspire is a small device implanted into the chest to deliver to deliver carefully timed mild stimulation to the airway during sleep. This controlled neurostimulation may achieve "patency" or firmness of the tissues in order to prevent their collapse. 
• Uvulopalatopharyngoplasty (UPPP). This surgical procedure removes excess tissue in the throat, soft palate, uvula, tongue, tonsils, and/or parts of the pharynx to create more space in the upper airway; this may prevent collapse airway collapse during sleep.
• Adenoidectomy. Removal of the adenoids (tonsils) make help make space in an otherwise crowded airway.
• Numerous other surgeries used to correct obstructive sleep apnea have been outlined clearly at this page hosted by the American Sleep Apnea Association.

Certain lifestyle changes or habits may not "cure" your sleep apnea, but they can certainly give you some relief. These include: 

• Positional therapy. Read here for a more detailed discussion about how just changing your sleep position can help those who snore or have mild apnea.
• Weight loss. Losing a few pounds, even just ten, can help shrink fat cells. Smaller fat cells retain less water and place less pressure on the tissues of the upper airway during sleep. This may reduce, if not completely eliminate, obstructive breathing patterns. Remember, even if you don't have noticeable fat pads in your neck, you may carry extra water weight in your feet during the day; when you lie down, the fluid recirculates and plumps up fat throughout the body, including in the neck area. 
• Gastric bypass or other surgical weight loss procedures. For those who are morbidly obese, these options may also help prevent obstructions secondarily, but these patients may need to have a sleep study prior to surgery to identify any preexisting sleep apnea so that the pre-surgical team can prepare proper anesthesia and respiratory therapies prior to the operation. 
• Smoking cessation. Smoking (of tobacco or any other substance) may inflame the upper airway and, in the case of tobacco, create a "rebound effect" in the upper away during the night because of short-term nicotine withdrawal. Smoking may also lead to Chronic Obstructive Pulmonary Disease, a chronic and irreversible respiratory disorder which can severely impact one's ability to breathe, especially at night while asleep.
• Daily aerobic exercise. Daily aerobic exercise may help to improve the tone of the tissues in the upper airway and may lead to weight loss and the shrinkage of fat cells which are partly to blame for obstructions of breathing at night.
• Change pillows or reduce the number of pillows used. If your pillow seems to be pushing your chin forward, it may be contributing to the mechanical obstruction of the airway. Find a pillow that allows your head to lie flat while still supporting your neck. Also, propping one's head up with multiple pillows may do the same thing. If you struggle to sleep with your head flat, it could be that you have a severe obstructive respiratory condition, and you should discuss this with your physician. 
• Play the didgeridoo. Seriously. There's some evidence that playing some form of wind instrument may help improve airway tone and build a skill called "circular breathing" which allows for better gas exchange. 

For more information about alternative therapies for sleep apnea which don't involve using PAP, click here. 

Alternatives: Therapies for Sleep Apnea that don't involve a mask

One of the concerns that some patients have when they consider that they might suffer from sleep apnea is whether they will have to use a CPAP machine and mask as therapy.

CPAP (Continuous Positive Airway Pressure) therapy is considered the gold standard for treatment of obstructive sleep apnea; until the 1980s, we didn't even have CPAP as an option, and the only way to treat sleep apnea was to perform a tracheostomy (by cutting a hole through the tissue in the throat to open up the airway). Therapy for obstructive sleep apnea, and especially CPAP, has come a long way for those who suffer from severe sleep breathing disorders. Machines are smaller and quiet and masks are smaller with more comfortable headgear and a better fit.

Still, some people may try CPAP treatment but find they cannot tolerate it. Others may have a milder form of sleep apnea and may possibly do just as well by undertaking an alternative treatment. There are other options, after all. Some of them are more invasive, or more controversial, or more useful to certain patients over others. They all have risks and costs to consider as well, and the rate of effectiveness for each alternative varies widely and depends upon a multitude of variables.

It is not the purpose of this website to favor one therapy or another, or to compare and contrast, but rather to illustrate the variety of options that patients with sleep-disordered breathing may have.

As always, your diagnoses and treatments are best discussed with your sleep physician, as this website cannot diagnose your problem or prescribe or advise as to which options are best for you. But if you are thinking you might qualify for a CPAP alternative or are willing to try other approaches, read on.

ALTERNATIVE DEVICES

• Oral devices.
  These are various kinds of dental devices which are molded to your unique jawline; they may help to realign the jaw overnight so that your airway can be opened while you sleep. These are not the over-the-counter mouthpieces; you must be fitted for one through a dentist with sleep dentistry credentials. Insurance is now starting to cover these devices and labs now have technologists who can help patients titrate them for optimal treatment.
• Expiratory positive airway pressure.
  This is a kind of nostril patch device that works by blowing against the patches during exhale, which may improve the "patency" or rigidity of the upper airway tissue and provide, for some, a kind of "tracheal traction" to create greater ease in inhalation.
• Oral pressure therapy.
  This works by using a small oral suction tube to draw the soft palate forward, which may stabilize the tongue and keep it from blocking the airway during sleep.

SURGICAL PROCEDURES

• Pillar procedure.
  This is a minimally invasive surgical procedure in which tiny implants are inserted into the soft palate. Their presence may reduce tissue vibration which can lead to snoring, sleep apnea and upper airway resistance syndrome.
• Somnoplasty.
  This is a minimally invasive surgical procedure using radio frequency (RF) energy to sculpt upper airway tissue under local anesthesia; this may effectively open the airway.
• Upper airway stimulation.

  

  © UMM/Inspire Medical Systems Inc

  This is a small device implanted into the chest to deliver to deliver carefully timed mild stimulation to the airway during sleep. This controlled neurostimulation may achieve "patency" or firmness of the tissues in order to prevent their collapse.
• Uvulopalatopharyngoplasty (UPPP).
  This surgical procedure removes excess tissue in the throat, soft palate, uvula, tongue, tonsils, and/or parts of the pharynx to create more space in the upper airway; this may prevent collapse airway collapse during sleep.
• Adenoidectomy.
  Removal of the adenoids (tonsils) make help make space in an otherwise crowded airway.
• Numerous other surgeries used to correct obstructive sleep apnea have been outlined clearly at this page hosted by the American Sleep Apnea Association.

Image courtesy NightBalance

LIFESTYLE CHANGES

• Positional therapy.
  This is admittedly "old school," but training yourself to sleep on your left or right side and avoiding sleep on the back or belly may help keep the airway open and reduce airway collapse leading to sleep apnea. Some patients sew tennis balls into the fronts or backs of their nightshirts to prevent them from rolling onto either of these sides.
• Weight loss.
  Losing a few pounds, even just ten, can help shrink fat cells. Smaller fat cells retain less water and place less pressure on the tissues of the upper airway during sleep. This may reduce, if not completely eliminate, obstructive breathing patterns. Remember, even if you don't have noticeable fat pads in your neck, you may carry extra water weight in your feet during the day; when you lie down, the fluid recirculates and plumps up fat throughout the body, including in the neck area.
  
  For those who are morbidly obese, gastric bypass and other surgical weight loss procedures may also help prevent obstructions secondarily, but these patients may need to have a sleep study prior to surgery to identify any preexisting sleep apnea so that the pre-surgical team can prepare proper anesthesia and respiratory therapies prior to the operation.
• Quit smoking.Smoking (of tobacco or any other substance) may inflame the upper airway and, in the case of tobacco, create a "rebound effect" in the upper away during the night because of short-term nicotine withdrawal. Smoking may also lead to Chronic Obstructive Pulmonary Disease, a chronic and irreversible respiratory disorder which can severely impact one's ability to breathe, especially at night while asleep.
• Daily aerobic exercise.
  Daily aerobic exercise may help to improve the tone of the tissues in the upper airway and may lead to weight loss and the shrinkage of fat cells which are partly to blame for obstructions of breathing at night.
• Change pillows or reduce the number of pillows used.
  If your pillow seems to be pushing your chin forward, it may be contributing to the mechanical obstruction of the airway. Find a pillow that allows your head to lie flat while still supporting your neck. Also, propping one's head up with multiple pillows may do the same thing. If you struggle to sleep with your head flat, it could be that you have a severe obstructive respiratory condition, and you should discuss this with your physician.
• Play the didgeridoo.

  

  "Didgeridoo - U. Dist Street Fair 1993 - 1"
  by Joe Mabel. CC BY-SA 3.0 

  
  Seriously. There's some evidence that playing some form of wind instrument may help improve airway tone and build a skill called "circular breathing" which allows for better gas exchange. Read more.

Things that likely don't work.

• Oxygen therapy.
  This definitely can't work for someone who's airway is collapsing as they sleep. An oxygen tank and cannula delivers oxygen, but it is not pressurized to the level necessary to open up the airway. PAP stands for "positive airway pressure," and it is this air pressure itself, not merely the presence O2, which makes the therapy useful.
• Nasal strips.
  Some people swear by these but theoretically they are only useful for nasal congestion. Problems with upper airway are not limited to the sinuses and nasal passages, but extend into the mouth, the larynx and parts of the upper pharynx, which is where obstruction takes place.
• Snore pillows.
  If these work, it is because they force you to practice positional therapy (see Lifestyle Changes, above), not because of the particular contour of the pillow. They are expensive and not largely proven to be any more effective than just choosing to sleep on your side.
• Sleep apps for your smartphone.
  There is no way you can treat sleep apnea, snoring or upper airway resistance using a phone app. All of these are mechanical issues of the airway that require some kind of physical application of external, manipulative or surgical therapy. It's not even clear whether any of the smartphone apps sold to help you identify sleep problems are even useful for predicting any kind of sleep quality. They do not tap your brainwaves like an electroencephalogram (EEG) does, so you can't be sure they are truly measuring any kind of sleep, much less specific stages; also, these apps cannot measure drops in nocturnal oxygen saturation or capture pertinent muscle movement. The one way you can use your phone is as a device for video and/or audio recording, of yourself or others while asleep, in order to demonstrate the potential presence of apnea or heavy snoring in action, but that is about it.
• Drugs.
  Nope, there's not a pill for sleep breathing disorders, which are mechanical issues of the upper airway and, therefore, not treatable by medication. In fact, many drugs (over the counter, prescription and illicit) can depress the upper airway or worsen underlying apnea, snoring or upper airway resistance. Right now there's research into medications for these issues, but that is about it.

Finally, here's a great article from Sleep Review that analyzes various alternatives to CPAP.



A friendly reminder that links to websites offering products does not imply endorsement by SleepyHeadCENTRAL.com.

SleepyHeadCENTRAL strongly encourages people with ongoing sleep health problems to approach a medical professional to determine appropriate differential diagnoses and treatment. This post, like all other posts on SHC, is not intended to substitute for medical advice.